Help

I am at a complete loss my insurance wont approve my surgery without a list of co-mobilities and proof of all the various work ups. Which I know is normal but the office of Dr Roy is giving me the run around and not responding to questions. They say the insurance has to approve me before they will tell me what they need or order testing. What do I do now my insurance quoted me they tried to talk with the doctor and it was said he could not come to the phone and he never replied back to my insurances phone call. So I was denied based on lack of information. The insurance rep. told me I qualified for the surgeons guidelines but not theirs. Now I love Dr Roy he is awesome is it just the staff or am I doing something wrong. I have to write a letter of appeal now and Im so depressed. Any advice I did ask Tri-care should I change my doctor they said no it might take longer just give it time. Sometimes I feel like time is just not something I have........I go for sleep study Thurs. I am kinda nervous have no clue what to expect. Please excuse me if Im rambling I am just so sad KIM Kimberly(kim)

Kim, I don't know anything about Tri-care but do know that there are several people who post here that have them as their insurance carrier so I am sure someone will help you out. My question is though is Dr. Roy your surgeon or your Primary Care Physician? That is important to know. Also I did want to reassure you that there is nothing to be afraid of with the sleep study. I have had two of them now and they aren't bad. Basically they attach a bunch of wires on your head (no pain at all), *****hest and legs. Then you spend the night. They monitor your sleep. If you need to get up to use the bathroom etc. they assist you and disconnect your from the wires pretty quickly. If they find you do have sleep apnea they might wake you up after a few hours and have you try out a cpap machine. That is where you wear a mask over your nose and it blows air into your lungs. Again this is all painless. Good luck with your journey and I hope you get things straightened out quickly.

Linda thank you so much for the support. Dr Rowe is my surgeon ( I Hope) I am waiting for my Primary Care Physician to call back to ask her for a letter referral. The insurance rep said it might help because she would be able to confirm health issues. I really thank you for the reassurance with the sleep study. It might be nice to sleep all night wires or not Thanks again Love and Laughter, Kim

You should just try to get Dr Bell as your surgeon. I swear I have tri-care and I didnt have probs like that. He was really super great with me (surgery wise), and Liz and Lynda took care of everything ins wise, the only thing I had to do was keep renewing my referal for the pre-op appts. I heard/read somewhere that if your BMI is over 50, Tri-care doesnt need you to have any other health issues wrong in order to approve the surgery. If your BMI isnt over 50, then Tri-care requires that you have at least 2 probs wrong, such as but not limited to, Diabetes, High blood pressure, sleep apnea, etc... the list is a big one. You could prolly call tri-care and get that list of what they think you should have wrong with you. I was lucky my BMI was 50.1 so I qualified. I had nothing else wrong with me. My PCP on base is Tonge-Martin, she is great and told me about Dr Bell. I do wish you the best. Feel free to email me anytime if you need more help or just need some support. I totally know what a pain in the @$$ Tri-care can be. Sincerely Ellie QUigely http://www.weightlosschronicle.com

Honestly, my opionion is that if they're giving you such a hard time now, it's not going to get any better in the long run. I NEVER had to do one thing with my insurance. The Dr's office handled everything. I'd look for a surgeon who's going to help you, not be more concerned with insurance approval than with you as a patient. Besides, how is the insurance supposed to approve you if you haven't had any tests proving medical necessity? Anyway- that is just my humble opinion. Good luck to yu whatever you decide to do. Sorry I can't ofer you any specific advice about your insurance carrier.

Lisa thanks for the reply I know what you mean Im going to talk with my Primary Care Doctor and double check if I met the insurance qualifications. See what tonight brings with the sleep apnea test.